全程超声引导下经皮门静脉穿刺胰岛移植治疗糖尿病16例报道  

Whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation for diabetes:a report of 16 cases

作　　者：段金良 庄博文 白芳 凌象超 龚金龙 杨道朋 朱晓峰[1] 何晓顺[1] 谢晓燕[2] 李延兵[3] 王长希[1] 胡安斌[1] Duan Jinliang;Zhuang Bowen;Bai Fang;Ling Xiangchao;Gong Jinlong;Yang Daopeng;Zhu Xiaofeng;He Xiaoshun;Xie Xiaoyan;Li Yanbing;Wang Changxi;Hu Anbin(Department of Organ Transplantation,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080;Department of Ultrasound,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080;Department of Endocrinology,The First Affiliated Hospital of Sun Yat-sen University Guangzhou,510080)

机构地区：[1]中山大学附属第一医院器官移植科,广州510080 [2]中山大学附属第一医院超声科,广州510080 [3]中山大学附属第一医院内分泌科,广州510080

出　　处：《中华器官移植杂志》2021年第12期733-737,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨全程超声引导下经皮门静脉穿刺胰岛移植治疗糖尿病的方法及应用价值。方法回顾性分析2018年10月至2021年5月在中山大学附属第一医院16例次接受全程超声引导下经皮门静脉穿刺胰岛移植治疗糖尿病的受者的临床资料。16例次全程通过超声引导完成移植管路经皮门静脉穿刺植入、胰岛输注监测、穿刺道预防出血处理及出血后的消融止血处理。结果10例受者[男8例,女2例,年龄(45.9±21.1)岁]共接受16次胰岛移植,其中5例接受1次胰岛移植,4例接受2次,1例接受3次。在所有移植过程中均实现一次穿刺成功,未损伤其他肝外器官,无持续性门静脉高压、门静脉栓塞、感染发生。3例次术后肝穿刺口出血,即行超声射频消融止血。16例次胰岛移植术后,全部受者血糖稳定维持在4~12 mmol/L;5例次(31.3%)实现胰岛素撤除两个月以上,10例次(62.5%)胰岛素用量较术前减少1/2以上;10例次(62.5%)空腹C肽水平恢复或高于正常水平,其余空腹C肽水平亦有提升。11例次(68.8%)胰岛移植后受者出现肝脏转氨酶短暂轻度升高,未见其他并发症。结论全程超声引导下经皮门静脉穿刺胰岛移植操作简便、安全性高,并可避免造影剂对受者肾损伤以及对术者和受者的X线辐射,是一种值得推广的胰岛移植方式。Objective To explore the application value of whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation.Methods From October 2018 to May 2021,16 diabetics underwent whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation at First Affiliated Hospital of Sun Yat-sen University.The whole process was guided by ultrasound for completing percutaneous portal vein puncture catheterization,islet infusion monitoring,bleeding prevention and ablation hemostasis after bleeding.Results Ten patients[8 males and 2 females with a mean age of(45.9±21.1)years]underwent 16 islet transplants,including one islet(5 cases),two islets(4 cases)and three islets(1 case).A single puncture was successfully performed without damage to other extrahepatic organs,persistent portal hypertension,portal vein embolism or infection.Bleeding at liver puncture site occurred in 3 cases and ultrasound radiofrequency ablation was performed for immediate hemostasis.Among them,postoperative blood glucose stabilized at 4~12 mmol/l post-operation.And 5 cases(31.3%)achieved insulin independence for>2 months and 10 cases(62.5%)lowered insulin dosage by>50%as compared with preoperative level.The level of fasting C-peptide recovered or was higher than normal in 10 cases(62.5%)and became obviously elevated in the remainders.In 11 cases(68.8%)of them,liver transaminase was briefly and mildly elevated post-operation,and no other complications were observed.Conclusions The whole-process ultrasound-guided percutaneous portal vein islet transplantation is both safe and feseasible.It avoids the injury of transplanted kidney caused by contrast agent and radiological radiation to operator and patient.It is a method of islet transplantation worth a wider popularization.

关 键 词：胰岛移植 糖尿病 超声 

分 类 号：R657.5[医药卫生—外科学]